title: [Acute, recent and sometimes persistent Mycoplasma pneumoniae infections associated with neurologic manifestations. Discussion of causal relations].
abstract: Neurological disorders associated with recent and sometimes persistent Mycoplasma pneumoniae infections were present in 9 patients, examined within the course of a year, during the 1980 epidemic in Saint-Etienne, France. Cases included 5 with acute polyneuritis, 2 with lymphocytic meningitis, 1 with a bilateral optic neuritis, and 1 with mild encephalitis presenting as an amnesic disorder. Causal relationships are examined with respect to semiological, biological, therapeutic and epidemiological data. Clinically an initial infection compatible with the mycoplasmic etiology and its time relationship with the nervous system lesion appear to be more significant than the inflammatory neurological symptoms and signs. It is often impossible to ascertain the efficiency of the antibiotic therapy, which thus cannot help to the aetiological diagnosis. From the biological point of view, though seroconversion by complement fixation test remains the basis of the diagnosis, it has been completed by the isolation of Mycoplasma pneumoniae in the blood of 3 of the patients, and by a longitudinal study of specific blood IgM levels in the 6 others. Presence in the CSF of these locally synthesised specific IgM during the early stages of the neurological disorders in 2 patients, constitutes a new significant fact for the physiopathological discussions and a basic fact to clarify the aetiological diagnosis. The concept of persistent infection is discussed with respect to the isolation of Mycoplasma pneumoniae in the blood at a late stage, and the abnormally long presence of high levels of specific serum IgM levels. This biological persistence does not always correspond to a chronic course of the clinical disease which was observed in only 3 of the patients. The mixed viral infection, present in 3 cases, is linked with immunity disorders due to Mycoplasma pneumoniae, which are mainly a cell immunity depression: this markedly complicates the analysis of causal relationships. Finally, the chronological order of the clinical and biological events remains of prime importance when studying each case individually, whereas epidemiological data are essential for establishing a posteriori that the neurological manifestations were true complications of the microorganism.
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003168:Complement Fixation Tests; D004660:Encephalitis / Q000209:etiology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000175:diagnosis; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D009422:Nervous System Diseases / Q000209:etiology* / Q000276:immunology; D009902:Optic Neuritis / Q000209:etiology; D011129:Polyradiculoneuropathy / Q000209:etiology; D013997:Time Factors
chemical_list: D007075:Immunoglobulin M
vernacular_title: Infections aiguës, récentes, et parfois persistantes à Mycoplasma pneumoniae, associées à des manifestations neurologiques. Discussion des liens de causalité.